Hammertoe surgery is an out patient procedure performed by Dr. Bennett to treat an abnormal curve or bend in the middle joint of the toe. This acquired deformity often makes moving the affected foot and toe painful, and difficult to fit comfortably in a shoe. Often, the affected toe will rub against the top and inside of a person’s shoe resulting in a corn or callus, and in extreme cases can ulcerate. If conservative or palliative care such as trimming the callus off and padding the area, or orthotics, or toe stretching exercises fail to ease the discomfort, hammer toe surgery is often recommended. During the surgery, the foot or just the toe involved is anesthetized, and Dr. Bennett will make an incision centered over the top of the affected toe. Depending on the severity of the deformity, there are various types of procedures that can be performed to correct or straighten the toe. Various instruments are used to expose the middle toe joint and remove or remodel bone as needed. Additional incisions may be made to prevent the toe from bending downward. Surgical hardware such as pins may be placed in the toe to aid in the healing process. Small absorbable and non-absorbable sutures will then be used close the surgical incision, and are the skin incisions are typically removed 10 to 14 days after the surgery.Causes of Hammer Toe
It is possible to be born with a hammertoe (congenital), but in most cases people develop the deformity later in life (acquired). Acquired causes include:
- Tightened tendons that cause the toe to curl downward
- Nerve injuries or problems with the spinal cord
- Stubbing, jamming, or breaking a toe
- Having a stroke
- Having a second toe that is longer than the big toe
- Wearing high heals or tight shoes that crowd the toes and don’t allow them to lie flat
Many people find first realize they have an advanced hammer toe after conservative treatment such as orthotics and toe strengthening excercises fial to relieve their pain. Patients with an advanced hammer toe may experience stiffness or cramping in their toe, pain in the middle joint or base of their toe or they might have toe and/ or foot pain that affects their ability to walk properly.
Dr. Bennett will ask about your symptoms and medical history to determine if hammer toe surgery is the proper course of treatment. A physical exam of the toe will be performed and x-rays may be taken. Hammer toe surgery may be recommended for patients with an advanced hammer toe to dleay the progression of the deformity and diminish discomfort.Types of Hammer Toe Surgery
Several surgical procedures are used to correct a hammer toe. Dr. Bennett will decide which method will be most beneficial to you depending on the severity of your deformity, the direction the toe is deviating and the length of the affected toe. Some common surgical methods include:
- Arthoplasty – To promote straightening, half of the joint located directly underneath the crooked part of the toe is removed. This gap that is left fills in with scar tissue over time. The result is a slightly shorter and straighter toe.
- Arthrodesis (fusion) – To promote straightening and to preserve the length of the toe, the joint under the contracture is removed just enough to promote end to end bone healing, and the result is one longer, straighter bone rather than 2 bones with a contracted joint. A wire or pin is inserted to aid healing which can either be left in place or removed.
- Tendon Transfer – Performed alone or in combination with the other procedures, a surgeon will take tendons from under the toe and re-route them to the top of the toe to promote straightening and a lower position of the toe rather than an elevated or contracted one.
- Basal phalangectomy – Performed to assist patients with severe stiffness, this procedure removes the base of the bone underneath the toe. This is not performed very often.
- Weil osteotomy – Performed to assist patients with severe stiffness, this procedure involves shortening the metatarsal bone and inserting a small screw to aid healing.
Although pre-surgery instructions may vary from patient to patient, Dr. Bennett will likely request that you arrive at St. Joseph’s hospital or surgical center one or two hours before the surgery. After you fill out your paperwork and get admitted to the facility, you will be evaluated by an anesthesiologist. Most hammer toe operations are performed under a local toe or digital block , which means your toe will be numb but you will be awake during the surgery. Some patients will be given general anesthesia and will sleep during the operation, but this is rarely needed. Depending on what type of anesthesia you receive, you may not be able to eat, drink, or take certain medications prior to surgery. You may also receive a sediative before the procedure to help you relax. Since the effect of sedatives can take a while to wear off, it’s important to arrange for someone to drive you home after your operation. Your doctor will give you specific instructions prior to your surgery so you can plan properly.Post-Operative Care
Following surgery you will be moved back to your room. Most patients will be sent home after resting for a few hours. When you are discharged, your foot will be bandaged and you will be given a protective surgical shoe to or boot to protect the surgical site and help you walk after surgery. Stiffness, swelling, and discomfort are common for several weeks following surgery. Pain is managed with narcotic and non narcotic medications, and many patients take ibuprofen only for a few days. A few patients report not taking any pain or anti inflammatory medications at all!
Full recovery typically takes one to three months, and can depend on which toe and how many were operated on, and how well you follow your surgeon’s post-operative instructions. Although specific instructions will vary from patient to patient and will often be specific to the type of surgery performed, there are a number of general rules which Dr. Bennett will suggest to ensure optimal healing. These include:
Keep your foot elevated as much as possible for the first few days after surgery (about 10 to 20 degrees above horizontal is best) and apply ice around the ankle to relieve swelling and pain.
Put crushed ice in a zip lock bag and cool down the inner, back and outer aspect of the ankle on the affected foot for 20 minutes, then remove it for 40 minutes. Repeat as necessary during your waking hours per your doctor’s instructions. Avoid walking or standing for long periods, especially during the first moth of recovery. If you smoke, quit or at least cut back. Smoking can slow or impair healing.Post-Operative Limitations
Following hammer toe surgery, certain activities may be unsafe or difficult to execute. Such activities may include:
- Walking – Many patients are able to walk with no aids or a cane following their surgery. However, mobility will remain somewhat limited for the first two weeks.
- Wearing regular shoes – After two to eight weeks, most patients are able to discontinue use of their postoperative boot or shoe and start wearing wide, comfortable footwear such as a running shoe. Patients with hardware implanted during surgery will need to wait until the hardware is removed before wearing their own footwear.
- Driving – Patients should not drive until they feel comfortable performing an emergency stop. This is typically three to eight weeks following surgery.
- Returning to work – If you are able to get a ride to work and your work does not involve a lot of standing or physical activity, you can often return to work within a week or two after surgery. Ideally, you should only return to work only if you can keep your foot elevated while you are there. For those with active jobs, it may be a month or two before Dr. Bennett clears you for working with no restrictions.
- Returning to sports and exercise – although the full healing process typically lasts up to a year, most patients can return to physical activity after three or four months. In some cases, excessive or prolonged swelling can delay complete healing, but ultimately most patients are enjoying full function within three to four months.
Dr. Richard Bennett, D.P.M., offers sports podiatry, diabetic foot care, and treatment of foot and ankle problems to residents of Chicago, Illinois and the surrounding area.